Institution: Centers for Disease Control and Prevention (CDC) and National Cancer Institute

Epidemiologic studies that link tobacco exposure biomarkers (measurable indicators of exposure) to adverse health effects are valuable for complementing existing toxicological information about harmful and potentially harmful constituents (HPHCs) present in tobacco products. The goal of this study is to examine associations between tobacco exposure biomarkers and tobacco-related diseases using the Golestan Cohort Study, a study that includes more than 50,000 adults (ages 40-75 years) in Northern Iran; subjects have provided urine specimens and tobacco use data and have been followed since 2004 for disease and mortality outcomes. Study aims are: (1) to characterize mean levels and distribution of tobacco constituents in users’ urine by type of tobacco used (e.g., cigarettes, hookah); (2) to compare the stability of biomarker levels over time in current smokers; and (3) to estimate associations between individual biomarkers of polyaromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and tobacco-specific nitrosamines (TSNAs) and the risk of disease and death. To accomplish these aims, investigators will first conduct a pilot study to assess biomarker levels in tobacco users and non-users and compare biomarker levels at two different time points. Second, investigators will conduct a full study in which they will define groups based on disease (i.e., cancer, heart disease, stroke, respiratory disease) as well as a control group. They will then examine the association between pre-diagnostic levels of urinary biomarkers of nicotine, PAHs, VOCs, and TSNAs and the risk of each disease. The results of this study will provide information on the associations between biomarkers of exposure and adverse health effects and may help to inform regulatory actions regarding HPHCs.